Family, health and life events

The menopause does not happen in isolation. Midlife is a time when changes in family dynamics, health problems and significant life events may coincide with menopausal symptoms. Women talked about what else was happening in their lives at the time of the menopause. Caring responsibilities for children and parents, bereavement, chronic illness and disease, divorce, financial concerns and other factors seemed to make symptoms worse and in some cases even to bring on the menopause.

Family life
Women’s lives are complex, particularly at midlife. As well as balancing a work life with domestic responsibilities, women may be caring for young children, teenagers, grandchildren, ageing parents, and in some cases their partner. Women talked about the strain of looking after toddlers alongside older children, of caring for children with special needs, of supporting teenagers through exams, and of children leaving home only to return at some stage to fill the ‘empty nest’. As the mother of two teenage boys put it, ‘Menstrual mother, teenage boys, just are not a healthy mix’.

Nancy is a teacher. She is married with three adult children. She started the menopause at age 45 and had her last period at 47. Ethnic background/nationality' White British.

Well I’m a bit almost embarrassed to say that I’m one of the very very lucky women who really didn’t notice it at all. The only symptoms I had were that my periods stopped. I think I was actually undergoing quite a lot of stress at the time because my Mum had been quite ill for some time and she had *Scleroderma and although she was living at home looking after herself she still needed a fair bit of help from me. She lived in the same village as us and I saw her every day and helped her every day sometimes during the night. I was also working and looking after the three kids so I was actually quite stressed at the time. My periods stopped, I knew I couldn’t be pregnant because my husband had had a vasectomy.

I did feel that perhaps this had happened to me because of the amount of stress I was under.

You mean your periods ending when they did?

Yes. Yes. I thought that may have had some bearing on it. I did talk to people about that, the GP and the specialist and they listened but they didn’t really comment on it. I think they didn’t really have any views about that. Maybe they didn’t have enough information about it. But it would be interesting to see whether that has happened to other women. Because I did feel that perhaps it was stress related because I wasn’t, I don’t think I was showing that many symptoms of stress in other ways other than being perhaps a bit more tired and ratty than I would normally be. But I think probably that could well have been the major symptom of the stress that I was under.

(* Note' Scleroderma is a chronic disease which affects the connective tissues surrounding the joints, blood vessels and internal organs beneath the affected area of skin).

Several women had become increasingly responsible for the well-being of older parents and in-laws. Instead of being free to pursue their own goals in later life they may have to ‘juggle between generations’, help with grandchildren, and be weighed down by a reversal in roles as parents become more dependent on their support and practical help. As part of the ‘sandwich generation’, some women felt they were being pulled in different directions, unable to please everybody, and some also felt guilty.

Louise is a postgraduate student. She is single with no children. She had a premature menopause at age 31 following removal of ovarian cysts. Ethnic background/nationality' White British.

The biggest part the menopause, well the side effects of the operation and the menopause, is my role within the family and having to live and care for my Mum.

Tell me a little bit about that.

It’s quite a difficult time, my Mum’s got Motor Neurone disease. It’s very rare very slow progressing but my Dad works long hard hours as an engineer and could be out from seven till six at night. And my Mum’s quite proud, she’s worked in care herself so she doesn’t particularly, it’s been a battle to get someone to come in and for her to allow us to get social services involved because we couldn’t cope. I’d then have to make a decision where I was living away, having to come back physically unwell myself but having to look after my Mum because my Dad couldn’t do it, she wouldn’t have anyone else and because she couldn’t let her health deteriorate although I’d let my health deteriorate. So trying not to hide from my Mum my emotions, my health problems and then go home and be ill literally. So I guess that’s one of the biggest things, it’s sort of affected that. Now she’s much more aware because it’s like I’ve been much more open, it’s hurting me, I’m not very well though she probably would pick up on the fact that I was white when I was going hobbling around but yeah the lesser of the two evils really but now she gets support in, we’re getting more support in and so my day becomes much more relieved and I’ve become much more of a daughter I guess instead of a sort of twenty, well twelve hour carer at her beck and call where there’s no mother-daughter relationship because we’re too busy having more of a professional sort of relationship where I’ve become a carer and not a daughter.

As well as caring responsibilities, worries about the family, relationship breakdowns, work, finances and the future can add to the burden of uncertainty, anxiety and stress women feel around the menopause.

Brenda is a part-time teacher. She is married with five children. She started the menopause at age 46. Ethnic background/nationality' White Orthodox Jewish.

Can you tell me a little bit about the other things that are going on in life around this menopause transition?

Right, right. First we have major money problems. I began to think I was unable to cope with everything partly because of that. But now I see that that’s just an additional thing. And secondly I have children turning into teenagers who are refusing to continue in the same schools at which they are at present and one of them choosing to do a career which seems to me totally inappropriate. And so these things are very stressful and my parents are getting older and my mother’s just been hospitalised, all these things just are and I see that’s the way life is.

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Age at interview:

46

Sex:

Female

Background:

Annette is a part-time dinner lady and carer. She is single with four children ranging in age from 2-22. She started the menopause at age 44. Ethnic background/nationality' White British.

I looked after my Dad before he passed away because he was diabetic, no legs. So I went up there regular. So that’s a big thing the children have missed because we were up there quite a lot at weekends. Couldn’t make it in the week because of my jobs, but most weekends we did make an effort to see my Dad, where we could go shopping and things for him so. In a way that’s, I know it sounds bad, but in a way that was very tiring. So in a way I haven’t got to deal with that no more weekends, so I can concentrate on the home. There’s a lot of work that needs doing on this home and at the moment I just haven’t got the energy. But I put it down to not just the menopause, I have got, well as you can see I’ve got a two and a half year old. And I don’t really have childminders, I mean the only one that has him is my sister, and once I’m home here at night I don’t go out. This is my life. At six o’clock I’m home, doing tea, wash the kids, bath the kids, well they bath themselves except for the baby. That’s another thing. Everything’s sort of changed since having [youngest son]; it’s been a lot of extra work really. Their Dad’s good. I mean he does come in and looks out, he does give him a bath now and again and things but, most of the responsibility is left down to me.

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Age at interview:

53

Sex:

Female

Background:

Denise is an administrator. She is married with two teenage sons. She started the menopause at age 50 and had her last period at 52. Ethnic background/nationality' White British.

Also of course it coincides with the age when your children are very often late teens flying the nest or going to university and going through the money quite happily and various other things like that. It coincides very often with, if you’ve been in a job a long time, changes. All sorts of things perhaps, indeed you sort of have your internal midlife crisis and what is going on, am I here for the rest of my life or should I make a break and try something new? So there’s an awful lot always going on about these years.

As well as that elderly parents very often are on the scene, either looking after them or indeed dealing with the bereavements etcetera. So it’s an age where quite a lot can go on but you don’t realise it because of course everyone has to face it so you don’t think you’re any way different or whatever. But it takes its toll I guess and more so on some.

So are you looking after your elderly parents at the moment?

I myself just went through quite a few, well, a couple of quite bad years when my mother was very poorly with a form of dementia and then broke her hip. So was hospitalised and she eventually passed away a few years ago. At the same time my Godmother by marriage I suppose broke her hip so she has very few relatives so we were visiting her. And of course then my mother-in-law became poorly and became bedridden and just a few years one after the other. It happens I think about this age. They are all of an age. My own father is still alive but getting poorly and so it just goes on but as I say, many others are in the same boat.

Have you had caring responsibilities then? Did your mum live with you?

No, other than visiting or looking after her, taking meals or just trying to look after my father who really was the primary carer but holding down a job, looking after the kids who were doing exams at that time, visiting, it as I say, just takes time. Travelling about, even though they lived fairly close to us just worrying about them I suppose. And dealing with the doctors and the hospitals and trying to help my father but as I say, quite a lot are in the same boat.

Ill-health
Though difficult to prove, some women wonder whether they may be more susceptible to ill-health as their oestrogen levels fall. The menopause and the onset of chronic health conditions may be connected. Conditions such as asthma, underactive thyroid, high blood pressure, high cholesterol, and arthritis, may be diagnosed or get worse around the menopause. Women also mentioned flare ups in ulcerative colitis, depression and kidney problems. Several women diagnosed with cancer at this time faced their own mortality (see ‘Changes in the body and keeping healthy’) (see Healthtalkbwebsites on: ‘Breast cancer’, ‘Breast screening’, ‘Cervical cancer’ and ‘Cervical screening’).

Judy is a senior lecturer. She is married with two teenage children. She started the menopause at age 40. Ethnic background/nationality' White British.

But the main issue for me is hitting 40 and that first change in what was a very very regular cycle coincided with a change in my health. Which I’ve subsequently been diagnosed with Myasthenia gravis, which is grave muscle weakness and I’ve developed this autoimmune condition in which my body creates antibodies against receptors in my muscles where my nerves and muscles meet and the upshot is I have double vision. And I just think there’s too much of a coincidence about the coinciding of the beginning of my menopause with this and I think it’s the protective factor of the reproductive cycle and removing that, or just sort of changing that, has had a change in my health and it was just a watershed really. So it wasn’t just a change in my fertility but also a whole change in my health.

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Age at interview:

55

Sex:

Female

Background:

Susan is the manager of a women's health centre. She lives with her partner and has no children. She started the menopause at age 45 and had her last period at 50. Ethnic background/nationality' White British.

It’s at a stage in your life when so many other things are going on. And that’s what makes it, that is where the sense of change and the notion that it is change is really compounded because I mean for me I was to lose my best friend. Co-incidentally I changed job although I’d been part of here for twenty years I didn’t actually come to work here until 1997. So that was a time of change. I’d been here working just full-time for twelve years so it was a period of change. You just felt that there were things going on that had a greater impact, you had a sense of things just changing and the loss of people. I know from women it’s the loss of children leaving home or the loss of a partner or there can be other changes at that time in your life that just seem so much more exaggerated because you’re going through this change.

It has changed but it's not over. I suppose for me it was compounded because I had other diagnoses then. I did have breast cancer then two years ago and so that I often think with the two running parallel in some ways because you do have an overwhelming sense of your own mortality. You do have existential feelings. You have feelings about your well-being and your health and where you might be. So I never I suppose that’s the bit that for me is a bit confused as well, is that what the menopause is, or was that something much more deeper that was going on that I was tuned into.

Well, jeepers it all seems to have been part and parcel of it. It seems to have been part and parcel of the whole thing. I just see them all as a bit connected. I personally can’t separate them out. I see them all being crammed into that 10 year period of my life or whatever from when I was 45 to 54. I just see that as being a kind of a ten year chunk that I entered quite early compared to others, and I just wish for myself good health from here on in, and good mental health, but the greatest confidence it gives you is if you can survive all that, you can survive a lot of things.

As well as their own health issues, women may also be supporting family members living with chronic illness and disease. Women spoke of their concerns for family members and friends suffering from conditions such as cancer, M.E., stroke, heart attack and diabetes.

Bereavement
Midlife is also a time when women may lose a partner, parents, brothers and sisters, and close friends. They feel devastated when parents die and realise that they are now ‘the one who’s at the edge’. Loss may be felt in other ways too. Women spoke about their sadness at being unable to communicate with parents diagnosed with dementia. Without the support networks they have relied on in the past for advice and reassurance, women can feel very lonely as they cope with the menopause (see ‘Support networks’).

Sandra is a bookkeeper. She is widowed with an adult daughter. She started the menopause at age 45. Ethnic background/nationality' White British.

My husband died 3 years ago which was unexpected so sort of very life changing that was.

Well it was very sudden because it wasn’t expected and it just happened. So we’d just finished building our own house as well so that did have quite an effect. The good thing was that I was aware, we did everything together so bills and insurances and everything like that, mortgages, it wasn’t as if I’d suddenly got all of this to deal with and didn’t know anything about it and how to do it. I think the thing that’s affected me most is the loneliness and not having somebody to, oh my daughter’s there but not having someone to go home to and discuss what you’ve done that day or sharing things. I would say it had more effect than even my father dying because it’s not. I went through the sadness and then I went through the anger because I thought he’s left me. I’m this age, I’m not going to meet anybody else because I’m this age and I’ve got that into my head now and I can’t get that out of my head and I probably don’t go out of my way to meet anybody at all because I don’t really think that anybody’s ever going to replace him.

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Age at interview:

50

Sex:

Female

Background:

Rose is a personnel manager. She is married with two adult children. She started the menopause at age 43 and had her last period at 45. Ethnic background/nationality' White British.

One of the things that I hadn’t thought to discuss with my GP is, obviously when I started to go through my menopause quite early, I spoke to my mother because I wanted to know what her experiences were, maybe she could give me a clue as to what I was likely to expect, if it was genetic hereditary and I didn’t realise but when we started discussing it, she didn’t really have a menopause I lost a brother when he was 17, my mother was 44. Overnight her periods ceased, she never had another one, but she never had any side effects either. She never had any hot flushes, difficult to know with things like mood swings because clearly she was going through a grieving process and a bereavement process. But for her, she would say “I never had a menopause. One day I was having regular periods”. She’d always had regular periods like me, they’d never been a problem to her and suddenly they ceased and that made me wonder, my own menopause started as I said when I was 43, 44 I was perimenopausal, that coincided with my father being diagnosed terminally ill and I was a main carer for his last three months along with my mother. And again, the irregular periods and things seemed to start when he died. And so I wondered if significant life changes like that can actually affect when women go through ‘the change’.

The menopause takes place against a backdrop of everyday life, with its joys, challenges, responsibilities and concerns. Many women are unsure whether it is the menopause, or other health issues and/or family events that are making them feel tired, unwell and at times miserable.